Face-lifting device

ABSTRACT

A device is described that can be used by surgeons to provide quick and accurate face-lifting maneuvers that minimize the amount of tissue that has to be removed. The device is comprised of a shaft with a relatively planar but possibly lenticulate and even slightly curved tip that can divide and energize various tissue planes causing contraction especially via the fibrous tissues. Various forms of energy can be delivered down the shaft to heat and cause desirable tissue contraction. The device can also include a temperature sensor that can be used to control power output.

[0001] This application is a continuation-in-part of U.S. patentapplication Ser. No. 09/475,635, titled “Surgical Device For PerformingFace-Lifting Surgery Using Radio Frequency Energy”, filed Dec. 30, 1999and U.S. patent application Ser. No. 09/478,172, titled “Surgical DeviceFor Performing Face-Lifting Surgery Using Electromagnetic Radiation”,filed Jan. 5, 2000 and U.S. patent application Ser. No. 09/588,436,titled “Thermal Radiation Facelift Device”, filed Jun. 6, 2000, allincorporated herein by reference.

BACKGROUND OF THE INVENTION

[0002] 1. Field of the Invention

[0003] The invention relates to face-lifting devices, and morespecifically, it relates to a surgical device for performingface-lifting while altering the tissue planes on the undersurface of theface using various forms of energy.

[0004] 2. Description of Related Art

[0005] Definitions, Critical Anatomy and Nomenclature:

[0006] Cutting (in surgery) will be defined as relatively cleanlybreaking through similar or dissimilar tissues with minimal adjacenttissue trauma and thus little tissue stretching, tearing or ripping.Lysis (in surgery) will be defined as breaking through similar ordissimilar tissues with or without adjacent tissue trauma and mayinvolve stretching, tearing or ripping. Depending upon the tissueslysed, the degree of stretching or tearing of lysed tissue edges may beinconsequential or may even result in a desirable benefit such as postsurgical contraction. Planes of tissue are not often flat and representthe curviform intersection of dissimilar tissues and are made at leastpartly of fibrous tissues, either loose and spongy or firm and tough.Planes between the soft internal organs are usually loose and spongy.Planes of tissues in the face and on bones are firm and tough.Undermining will be defined as tissue separation either within orbetween defined tissue planes. Undermining may be sharp (instrument) ordull (instrument) depending upon the amount of fibrous tissue binding orexisting between the tissue planes to be separated. Undermining isusually performed, as is most surgery, with the intention of minimizingtrauma. Sharp instrument undermining is usually performed to separatehighly fibrous or collagenous tissues; however, sharp underminingsuffers from the risk of penetrating adjacent tissues inadvertentlybecause of loss of ability to follow the desired plane. Inability tofollow or maintain the plane in sharp undermining is frequently due tolimited visibility, difficulty “feeling” the fibrous plane, or scarring(collagen fibrosis) resulting from previous trauma or surgery. Evenexperienced surgeons may from time to time lose the correct plane ofsharp undermining; great skill is required. Blunt undermining allows arounded, non-sharp tipped, instrument or even human finger to find thepath of least resistance between tissues; once the desired plane isfound by the surgeon, it is easy to maintain the plane of bluntundermining until the task is complete. Unfortunately, blunt underminingbetween highly fibrous tissues such as the human face usually causestunneling with thick fibrous walls. Dissection usually implies sortingout and identification of tissues and usually implies that some sort ofundermining has been performed to isolate the desired structure(s). Inface-lifting surgery, plastic surgeons have so commonly used the termsundermining and dissection interchangeably that they have becomesynonymous in this specific situation. Tracking means to maintain adirection of movement upon forcing a tissue-separating instrumentwithout unpredictable horizontal movement or leaving the desired tissueplane(s). Planar tracking means to stay in the same tissue planes.Linear tracking means to move uniformly in a straight or uniformlycurved path without unpredictable movement. Groups of linear tracks mayform a network that creates an undermined tissue plane.

[0007] Anatomical Perspective: Lysis or undermining in one dimension(linear=x) implies forming a tunnel. Lysing or undermining in 2dimensions at any one instant forms a plane (x,y). Traditional face-liftundermining is done just under the leather (dermis) layer of the skinwhere dermis joins underlying fat (or subcutaneous (SQ) fat). Evendeeper within the SQ fat run larger blood vessels and delicate,non-regenerating motor nerves to the muscles that give the human facemotion and expression. Trauma to these nerves can cause a permanentfacial deformity or palsy. Deep beneath the SQ fat reside the musclesand glands of the face. (The relevant face-lift anatomy is described inMicheli-Pellegrini V. Surgical Anatomy and Dynamics in Face Lifts.Facial Plastic Surgery. 1992:8:1-10. and Gosain AK et al. SurgicalAnatomy of the SMAS: a reinvestigation. Plast Reconstr Surg. 1993:92:1254-1263. and Jost G, Lamouche G. SMAS in rhytidectomy. AestheticPlast Surg 6:69,1982.) The SQ fat differs from body location to bodylocation. On the face, the SQ fat has many fiber-bundles (septae)carrying nerves and blood vessels. If a surgeon were to move, shove, orforwardly-push a blunt, dull-tipped, 1-inch chisel or pencil shapeddevice through the fat of the face where SQ abuts the dermis, the sheerthickness of the fiber bundles would likely cause slippage of the deviceand result in the formation of pockets or tunnels surrounded bycompacted fiber bundles or septae. Proper performance of a face-liftinvolves breaking the septae at a proper level to avoid damaging moreimportant structures such as blood vessels and nerves and glands.

[0008] Disadvantages of the current techniques are numerous.Face-lifting devices described in the prior art resemble underminingdevices that were constructed with cutting edges that rely entirely onthe skill of the surgeon to maintain control. Inadvertent lateralcutting or tissue trauma may be difficult to control. In addition, speedof separation is important to reduce the time that the patient isexposed to anesthetic drugs; time duration of anesthesia may be directlyrelated to the risk of anesthetic complications. There are two principlelocations for face lift undermining (dissection). In the more commonlower facelift (cheek/neck-lift), undermining in the subcutaneoustissues is customarily performed; in the less common upper facelift(which approximates brow-lifting) undermining in the subgaleal ortemporalis fascia plane is customarily performed. Use of prior artundermining devices (including scissors, sharp rhytisectors, etc.) inthese planes during cosmetic surgery has, at times, resulted in unwantedcutting, trauma or perforation of adjacent structures. Scissors andrhytisectors are planar cutting instruments; thus, the position of thecutting edges with respect to the surface of the face is controllableonly by the surgeon who must estimate cutting edge's location as no 3rddimensional bulbous limitation exists. Unfortunately, scissors with 3dimensionally “bulbous”, rounded tips cannot close all the way to cuttarget tissue. Scissors with 2 dimensionally rounded tips can close allthe way to cut target tissue but may wander inadvertently between tissueplanes due to the thin third dimension (thickness) of the scissorsblades.

[0009] Current face-lifting instruments that cut with other than manualenergy do not address the novel concept of a “protected plane” duringenergized face-lifting dissection. Current lasers must be fired frompositions outside the patient to energize tissue within the face to cutin a very imprecise fashion. (See “Manual of Tumescent Liposculpture andLaser Cosmetic Surgery” by Cook, R C. and Cook, K. K, Lippincott,Williams, and Wilkins, Philadelphia ISBN: 0-7817-1987-9,1999) Tissue isdamaged with little control. Complications from the aforementionedtechnique have been summarized by Jacobs et al. in Dermatologic Surgery26: 625-632, 2000.

[0010] Current electrosurgical devices for use in general surgery mustbe delivered through large open pockets or through the limited accessand slow moving, tedious endoscopes if they are to see use inface-lifting. None are similar in shape or function to the instantinvention.

[0011] U.S. Pat. No. 5,776,092 by Farin describes a single tube devicethat can deliver laser, ultrasound or radio frequency devices to treattissue. However, Farin's device is not intended for separating tissueplanes and is susceptible to catching, tearing or puncturing the tissuewhen manipulated. It would be advantageous to provide a safe harbor forthe precise application of energy to proper face-lift tissues to beseparated and energized while excluding vital structures such as nervesand delicate vessels and maintaining an exact distance from the verydelicate surface of the skin. It would be additionally advantageous forthe same provisions to allow for a uniform forward tracking and feel ofmotion of the device that provides a surgeon with instantaneousknowledge. Properly sized and placed protrusions and recessions addressall of these problems in a manner not previously possible.

[0012] One of the most recent competing procedures to incompletelydissect/lyse/cut a face-lift plane is traditional or ultrasonicliposuction. Unfortunately, dissection is incomplete as relatively roundcannulas only make round tunnels. The tissues between the tunnels mustbe cut in a separate step by the surgeon using scissors in order tocreate a plane. During this separate step, when the scissors cuts thefiber tissues and blood vessels constituting the walls of the tunnels,bleeding and trauma occur and frequently require spot coagulation undervisualization. Other severe drawbacks of the incomplete undermining thatliposuction cannulas perform is the common trauma and resultant mouthdroop paralysis that occurs in the hands of even prominent surgeons whenthe delicate and anatomically unpredictable (20% of the population)marginal mandibular nerve is cut. Additionally, ultrasonic cannulasbecome hot and can cause thermal burns called “end hits” when thecannula tip is thrust against the inside of the skin as is common duringthe procedure.

[0013] Just as sharp undermining or dissection has its disadvantages, aspreviously mentioned, blunt dissection suffers from its own difficultiesas well. Forcing a blunt object through tissue avoids indiscriminatesharp cutting of important structures (nerves, vessels). Bluntundermining compacts the stronger, firmer, strands of collagen evencontained within tissues as soft fat into thicker “bands” (some overlythick for uniform cutting). Undesirably for a face-lift, traditionalblunt object undermining may indiscriminately force aside and compactfibrous tissue septae causing incomplete lysis or freeing of thetissues. Also unfortunately for face-lifting, traditionalpurely-blunt-object undermining will result in random motion oruncontrollable-slippage of the underminer tip on forward motion andthusly loss of precise tracking of the underminer through target tissue.

[0014] Currently it takes surgeons between 20 minutes and one hour tocarefully dissect/undermine/lyse/lift a lower face while caring tocoagulate blood vessels. It usually takes between 10 minutes and 30minutes, depending upon the patient to spot coagulate/seal all of theblood vessels that were cut during the aforementioned lysing portion ofthe face-lifting. For upper face-lifting, times are less than half thatmentioned for lower face-lifting. The principle preferred embodiment ofthe invention would reduce time for a surgeon to do both the duties oflysing and coagulation since the device performs both tasks as well asaids in maintaining proper positioning and tracking. The time reductionshould be at least 50-75%. Reduced operating time means less time awound is open to potential infection, lowered surgical costs and lesstime and therefore less risk under anesthesia and thus a generalimprovement in the procedure.

[0015] There exists a special subset of the general population that maybenefit uniquely from the present invention. Men and women between theages of 45 and 55 are just beginning to droop and develop folds.However, there is not much undulating wrinkling as in older patients.Currently long incisions of 10-20 cm are made around each of the twoears, for the purposes of hiding the scars; skin is cut out anddiscarded and the remaining skin stretched. Skin does not thicken inresponse to stretching; it only thins. Unfortunately, some plasticsurgeons in the early 1990's advocated “prophylactic” or “preemptive”face-lifting on women in their 40's purportedly to “stay ahead ofnature.” This philosophy has now been discounted and discredited by thevast majority of reputable experts.

[0016] Given the disadvantages and deficiencies of current face-liftingtechniques, a need exists for a device that provides a fast and safealternative. The present invention combines a unique lysing design withvarious forms of energy to efficiently lyse and simultaneously inducecontraction desirable in face-lifting. The present invention provides aprocess for human face-lifting, which can be used in hospitals as wellas office-based surgery and minimizes pain and risk of injury.

SUMMARY OF THE INVENTION

[0017] It is an object of the present invention is to provide a methodand a device that can be used by surgeons to provide quick and accurateface-lifting or tightening maneuvers that minimize the amount of tissuethat has to be removed.

[0018] It is another object of the invention to provide a surgicalface-lifting device that easily maintains the proper dissection planewhile lysing and delivers energy to the internal collagenous tissues ofthe face during tangential movement to induce skin tightening. Thiswould be exemplified by the protrusion/recession version of the tip.

[0019] Another object of the invention is to provide an underminingdevice that can position lysing surfaces at a proper level forcontrolled and safe fibrous tissue separation during a face-lift.

[0020] The device is comprised of a hollow or solid shaft with arelatively planar tip that can be easily positioned between dissectionplanes in tissue and then manipulated to separate tissue planes and lysefibrous tissue. It has been shown that thermal effects of energyapplication to the collagenous (dermal, superficial platysma musculatureand other) tissues of the face in the facelift plane can causecosmetically desirable contraction of the dermal tissues with beneficialtightening of the facial tissues. Accordingly, the invention provides anenergy source and delivering means, which delivers energy to the distalend of the shaft. A temperature sensor monitors the tissue temperature,and control electronics process temperature information to control thepower output for optimum tissue contraction. An optional secondary lightsource that is visible to the surgeon can be used to help visualize thelocation of the laser exit window. The various forms of energy that maybe used to energize various portions of the device are multi-chromaticlight, monochromatic light, laser light, radio frequency electricalenergy, vibrational energy, ultrasonic energy, microwave energy, thermalenergies or any combination thereof.

[0021] An embodiment of the invention has a plurality of protrudingmembers on the distal end of the shaft separated by at least oneinterstitial lysing segment, wherein the lysing segment is recessedrelative to the protruding members.

[0022] In another embodiment, the bulbous-lysing (projection-recession)tip is absent. A planar, round or geometric shaft may terminate in somegeometry of tip that is nonetheless relatively planar. The tip shapewhen seen from above or below may be rounded, squared, rectangular,serrated, scalloped, grooved, or geometric. Curved and lenticulateshapes may also be used. The tip shape when seen from the frontal viewmay be oval, rectangular, serrated, scalloped, grooved, or geometric.

[0023] Although an embodiment provides a shaft that has across-sectional shape that is flat or planar, acceptable alternativeversions of the shaft may be oval, circular, trapezoidal or geometric oncross-section. Although an embodiment provides a tip having a shape withalternating protrusions and recessions, acceptable alternative versionsof the tip shape may be semicircular, lenticulate or geometric.Alternatively, a non-energized protrusion-recession shaped tip may beused as well as other traditional instruments such as scissors to createthe lift plane; this would be followed some time later, seconds tominutes, by the passage of a (non-tangentially) energized device lackingthe preferred tip shape.

[0024] In one embodiment of the invention, the user sets the desiredtissue temperature on an external control unit using a touch pad orother user interface. The shaft of the device is then inserted through asmall (˜1 cm long) incision and positioned at the desired tissue plane.For lower face-lifting the surgeon makes these relatively smallincisions only in the skin in front of the ears and under the chin.Forward and lifting force are then applied to the shaft of the device bythe surgeon's hand to separate tissue planes while the shape of thedevice excludes critical structures (nerves, vessels) thus avoidingentanglement or trauma or indiscriminate cutting of these importantstructures. The same protrusions (in the most-preferred embodiment) thatexclude critical structures by virtue of their relationship to thecutting recessed segments also serve to position the depth of thepresent invention with respect to the lower dermis. The spacing of theprotrusions (bulbs) and recessions (lysing segments) maintains thetracking of the instrument. The beneficial feeling of “tracking” isinstantly palpable by the surgeon on device motion and requires nomonitor to know how the device is moving. Both the number and spacing ofprotrusions in one embodiment will aid in reducing wobble or lateral(horizontal) slippage during forward thrusting of the shaft. Verticalslippage is prohibited as well in one embodiment; the width of theprotrusions/bulbs maintains the correct distance between thelysing/recessed segments and the delicate underside of the superficialskin or dermis. Beneficially, the tip of the device and the action ofthe device can be felt/appreciated without direct visualization(endoscope). The surgeon can palpably feel whether the device istracking in the proper location; the feel of the device as it moves withpalpable and easily grade-able resistance through the facial tissues canimmediately tell the user the location and the amount of underminingthat has occurred at that location.

[0025] Protrusions & Recession Embodiment

[0026] In this embodiment, the tip is comprised of alternating, butrelatively symmetrical-across-a-midline, protrusions and recessions. Theprotrusions can be bulbous, geometric, etc., as long as the tips of theprotrusions are able to push and compress tissues into the cuttingrecessed segments. The recessed segments should have a relatively sharpedge that effectively lyses the tissue that comes into contact as thedevice is pushed forward. The close spacing of the grooves (caused bythe alternation of tip protrusions and recessions) provides the userwith a feel during forced tissue movement and significantly limitsslippage. The tip of the device, and the action of the device can befelt/appreciated without direct visualization (endoscope).

[0027] Laser-Energized Embodiment

[0028] In this embodiment laser light is transmitted from the laser tothe hand piece and down the shaft and exits an optical window near thedistal end of the shaft to heat the tissue that lies near the window.With the device positioned “window-up”, the laser light will propagateaway from the face to effectively heat the skin layer from the insideout. By selecting an appropriate laser wavelength, the laser penetrationdepth can be adjusted to control the thickness of heated tissue. Forskin tightening, a CO₂ laser with a wavelength of 10 μm will deliverdesirable results. Other usable lasers include erbium, holmium andneodymium. The purpose of the laser energy is to alter/irritate thecollagen so as to controllably cause later shrinkage and to optionallycontrol bleeding. For laser sources that are invisible to the human eye,the device may offer the user the option to simultaneously transmitvisible light down the shaft to give the user the ability to visualizethe region being treated. For example, red light that is easilytransmitted through several millimeters of skin could be safely used toguide the surgeon. Laser irradiation can be controlled manually by theuser or automatically to prevent excessive or inappropriate thermaldamage.

[0029] Light Embodiment

[0030] In an alternative embodiment energized by polychromatic light,light is transmitted down or formed in the tip or the shaft and exits anoptical window near the distal end of the shaft to heat the tissue thatlies near the window. The purpose of the light energy is toalter/irritate the collagen so as to controllably cause later shrinkageand to optionally control bleeding. The light may contain wavelengthsboth visible and invisible to the human eye.

[0031] Temperature-Measuring Embodiment

[0032] In this embodiment (which may be combined with any of the otherembodiments), the temperature of the target tissue is measured with anon-contact temperature sensor and the value displayed and used by thelaser control unit to actively control the laser power. The temperaturesensor can be an infrared temperature sensor, but other conventionalsensors may be used, such as fiber optic fluorescence temperaturesensors, and thermocouple sensors.

[0033] Low-Mid Frequency “Regular” Ultrasound-Energized Embodiment

[0034] In another energized embodiment in order to improve lysingefficiency, the device incorporates an ultrasound transducer into thehand piece that transmits ultrasound energy in the 3,000 Hz to 30,000 Hzrange down the shaft to the tip. Vibrational energyregistered/transferred in tissues surrounding the tip and any preplannedsurface irregularities will be converted to tissue-altering heat thatwill contribute to facial tissue contraction.

[0035] High-Frequency Ultrasonic-Energized Embodiment

[0036] In another embodiment, high-frequency ultrasonic (10 MHz to 100MHz) piezoelectric transducers may are located on upper and/or lowersides of the planes of the instrument preferably near to the tip. In oneultrasonic embodiment, piezoelectric ultrasonic transducers are usuallylocated in the handle or lower shaft of the instrument.

[0037] Reciprocating Energy Embodiment

[0038] In another energized embodiment, in order to improve lysingefficiency, the device incorporates an electrically-driven orpneumatic-driven motor and gears in the hand piece to move the shaft andtip (in unison) at adjustable frequencies between 100 and 2,000 Hz withexcursions (throws) varying from ½ mm to 2 cm. The motion of the surgeons arm with these devices is expected to be <<1 Hz.

[0039] Electrosurgical/Radiofrequency-Energized Embodiment

[0040] In another embodiment, the recessed cutting segments of thedevice are energized by an electrosurgical RF generator to improvelysing and allow RF-heating of tissue. Electrosurgical/radiofrequencysegments may also be located on upper and/or lower sides of the planesof the instrument preferably near to the tip.

[0041] Ionic Fluid/Electrosurgical-Energized “Arthrocare™” Embodiment

[0042] In a further embodiment, an ionic fluid may exude from more thanone area that is in contact with underlying electrodes allowing passageof tissue-altering energy preferably near to the tip.

[0043] Thermal/Heating-Iron-Energized Embodiment

[0044] In an alternate embodiment, thermal or resistive elements mayalso be located on upper and/or lower sides of the planes of theinstrument preferably near to the tip.

[0045] Microwave-Energized Embodiment

[0046] In a further embodiment, microwave-transmitting elements may alsobe located on upper and/or lower sides of the planes of the instrumentpreferably near to the tip.

[0047] The present invention can be used to improve the efficacy andsafety of face-lifting and face-tightening and is thus useful in avariety of cosmetic procedures. The forgoing and other objects,features, and advantages of the present invention will become apparentfrom the following description and accompanying drawings.

[0048] Although in one embodiment, the shaft's cross-sectional shape isflat or planar, acceptable alternative versions of the shaft may beoval, circular, trapezoidal or geometric on cross-section. Although inone embodiment, the tip's shape has alternating protrusions andrecessions, acceptable alternative versions of the tip shape may besemicircular, lenticulate or geometric. Alternatively, a non-energizedprotrusion-recession shaped tip may be used as well as other traditionalinstruments such as scissors to create the lift plane; this would befollowed some time later, seconds to minutes, by the passage of a(non-tangentially) energized device lacking the tip shape.

BRIEF DESCRIPTION OF THE DRAWINGS

[0049]FIG. 1 shows a partial top view of the face-lift apparatus 10 ofthe present invention as it is being used.

[0050]FIG. 2 is a side view of the face-lift apparatus 10.

[0051]FIG. 3 is an enlarged plan or top view of the tip 2 as used inupper face-lift.

[0052]FIG. 4 shows an off-center frontal view of the tip of face-liftapparatus protrusions and recessions.

[0053]FIG. 5 is a side view of the present invention 10 with detachablehandle 78 that fits over exogenous laser source.

[0054]FIG. 6 is a top view of the present invention 10 with detachablehandle 78 that fits over exogenous laser source.

[0055]FIG. 7 is a cut-open side view of the present invention 10 withdetachable handle 78 wherein shaft 4 acts as a waveguide 44 to allowlaser light 53 to move to and exit from window 50.

[0056] FIGS. 8A-F are enlarged plan or top views of several varieties ofshapes of the tip as used in upper face-lift procedures.

[0057]FIG. 9A is an enlarged plan or top view of ahigh-frequency-ultrasound-energized face-lift apparatus 1200.

[0058]FIG. 9B is a side view of the of thehigh-frequency-ultrasound-energized face-lift apparatus 1200 showingelements identical to those in FIG. 9A in a different perspective.

[0059]FIG. 10A is a side view of the electrically-driven-reciprocatingface-lift apparatus 900.

[0060]FIG. 10B is an enlarged plan or top view of the of theelectrically-driven-reciprocating face-lift apparatus 900 showingelements identical to those in FIG. 10A in a different perspective.

[0061]FIG. 10C is a side view of the pneumatically-driven-reciprocatingface-lift apparatus 1000.

[0062]FIG. 10D is a side view of the suction-driven-reciprocatingface-lift apparatus 1100.

[0063]FIG. 11 is a side view of the face-lift apparatus 110. The tip 102may be slightly larger than the shaft 104 to which it is attached.

[0064]FIG. 12 is an enlarged plan or top view of the tip 102 as used inupper facelifts.

[0065]FIG. 13 is another enlarged plan or top view of a tip 102.

[0066]FIG. 14 is an enlarged partial cross section of a tip taken at14-14 of FIG. 12.

[0067]FIG. 15 is an illustration of a face-lift apparatus.

[0068]FIG. 16 is a face-lift apparatus where the electrosurgicalhandpiece 118 and handle 106 have been combined to form integral unit134.

[0069]FIG. 17 represents a top or plan view of the ionic fluidelectrosurgical energized variant of the face-lifting device.

[0070]FIG. 18 represents a side view of the ionic fluid electrosurgicalenergized variant of the face-lifting device as shown in FIG. 18.

[0071]FIGS. 19A and B represent top views of the ionic fluidelectrosurgical energized variant of the face-lifting device.

[0072]FIG. 20 is a side view of the face-lift apparatus 210.

[0073]FIG. 21 is an enlarged plan or top view of the tip 202 as used inupper facelift.

[0074]FIG. 22 shows an off-center frontal view of the tip of theface-lift apparatus protrusions and recessions.

[0075]FIG. 23 shows a cross sectional view of an embodiment of theface-lift device 210 of the present invention.

[0076]FIG. 24 shows an alternative embodiment of the present inventionthat reduces the thermal load to the shaft.

[0077]FIG. 25 shows an alternative embodiment of the present inventionin which tissue heating is achieved by the direct contact with a hotsurface.

[0078]FIG. 26 is an enlarged plan or top view of a microwave-energizedface-lift apparatus 1400.

[0079]FIG. 27 is a side view of the of the microwave-energized face-liftapparatus.

DETAILED DESCRIPTION OF THE INVENTION

[0080] The present invention provides a device that can be used bysurgeons to provide quick and accurate face-lifting maneuvers thatminimize the amount of tissue that has to be removed. The device iscomprised of a hollow undermining shaft that can be easily positionedbetween dissection planes in tissue and then manipulated to separatetissue planes and lyse fibrous tissue. A laser light source anddelivering means delivers energy to the distal end of the shaft.Embodiments of the invention provide a planar application of energy. Atemperature sensor monitors the tissue temperature, and controlelectronics process temperature information to control the laser powerfor optimum tissue contraction. An optional secondary light source thatis visible to the surgeon can be used to help visualize the location ofthe laser exit window. Optionally the device can also use ultrasoundenergy delivered down the shaft to improve tissue lysing.

[0081] Laser-Energized Embodiment

[0082]FIG. 1 shows a partial top view of the face-lift apparatus 10 ofthe present invention as it is being used. The handle 6 of the apparatus10 is gripped in the hand 12 of the user of the device. The shaft 4 withthe special lysing tip 2 of the face-lift apparatus 10 is insertedthrough an opening 8 at a suitable location on the face of a patient.Dashed lines indicate the portion of the device hidden from view underthe skin. Curved stretch lines indicate the upward force applied on thedevice 10 and shaft 4 and the overlying skin of the face. The apparatusmay then be thrust forwardly while lifted forcefully by the operator toperform its function and maintain the plane of undermining. Window 50(dashed and hidden from clear view in this representation) allows egressfor laser light delivered to apparatus 10 via light delivery meanscontained in conduit 9. The conduit also contains the necessaryelectrical control wires necessary for device operation.

[0083]FIG. 2 is a side view of the face-lift apparatus 10. The tip 2 maybe slightly larger than the shaft 4. The tip 2 can be a separate piecethat is secured to shaft 4 by a variety of methods such as a snapmechanism, mating grooves, plastic sonic welding, etc. Alternatively, inthis model tip 2 can be integral or a continuation of shaft 4 made ofsimilar metal or materials. The tip 2 may also be constructed ofmaterials that are both electrically non-conductive and of low thermalconductivity; such materials might be porcelain, ceramics or plastics.An optional electrically conductive element 61 brings RF electrosurgicalenergy to metal or electrically conductive elements mounted in therecessions (see FIG. 3). The shaft 4 is tubular in shape or can be asomewhat flattened tube oblong in cross section and possibly geometricas well. The shaft 4 is made of metal with a hollow interior that cancontain insulated wire or wires 61. Alternatively, the shaft 4 may bemade of plastic that will act as its own insulation about wire orelectrically conductive element 61. The optional electrically conductiveelement 61 internal to shaft 4 conducts electrical impulses or RFsignals from an optional external power/control unit (such as aValleylab Surgistat, Boulder, Colo.). Hidden from this direct viewlocated at the most proximal portion of the groove is electricallyconductive element 81, powered by electrical source 18, which effectsforward lysing and is located at the terminus of conductive element 61.An optional temperature sensor 35 (See FIG. 4) placed near the distaltip of the shaft is used to monitor the local temperature. Thisinformation can be used by the control electronics to control the energydelivered to the tip. An optional mid and low frequency ultrasoundtransducer 32 (See FIGS. 2 and 3) can also be activated to transmitenergy to the tip 2 and provide additional heating and improve lysing.

[0084]FIG. 3 is an enlarged plan or top view of the tip 2 as used inupper face-lift. This tip 2 shows four protrusions 26 and threerecessions 28. The groove created by the tapering recessions may be upto one centimeter in length. The width of this tip varies between 12 mmand 20 mm and the thickness varies between 3 mm and 4 mm. Optical window50 allows laser light to exit the shaft and irradiate tissue directlyabove. A light delivery means which can be an optical fiber or hollowwaveguide (such as metal-coated plastic manufactured by PolymicroTechnologies, Inc of Phoenix, Ariz.) 52 is contained in conduit 9. Theconduit 9 can also be an articulating arm as is commonly used insurgical laser systems. Additional control wires and power are deliveredto the handpiece in the conduit 9. The user can enable or disable thelaser through control switch 55. This embodiment may also include thecurrent source 18 and electrodes 81 as shown in FIG. 2.

[0085]FIG. 4 shows an off-center frontal view of the tip of face-liftapparatus protrusions and recessions. The tip 2 has four protrusions 26and three recessions 28 which optionally contain seated conductiveelements 81. Window 50, possibly made of Germanium, allowing egress oflaser light and collection of data by temperature sensor 35, are alsolocated on the tip and may be of varying sizes. The width of this tipvaries between 5 mm and 10 mm while the thickness may vary between 2 mmand 4 mm. The tip, however, is not constrained by those dimensions.

[0086]FIG. 5 is a side view of the present invention 10 with detachablehandle 78 that fits over exogenous laser source 77 such as a SharplanFlashscanner or a Coherent Ultrapulse. The hollow section 44 of shaft 4may act as a waveguide or may contain a metal-coated plastic fiberopticor waveguide to allow laser light to move to and exit from window 50near tip 2. Window 50 allows egress for laser light delivered toapparatus 10. Laser sources known to be usable in the present inventioninclude both pulsed and continuous wave lasers such as CO₂, erbium YAG,Nd:YAG and Yf:YAG.

[0087]FIG. 6 is a top view of the present invention 10 with detachablehandle 78 that fits over exogenous laser source 77 such as a SharplanFlashscanner or a Coherent Ultrapulse. Shaft 4 may act as a waveguide ormay contain a metal-coated plastic fiberoptic or waveguide to allowlaser light to move to and exit from window 50 that allows egress forlaser light delivered to apparatus 10.

[0088]FIG. 7 is a cut-open side view of the present invention 10 withdetachable handle 78 wherein shaft 4 acts as a waveguide 44 to allowlaser light 53 to move to and exit from window 50. An optical element 51is used to reflect the laser light out through the window. In analternative embodiment, the waveguide 44 formed by the internal surfaceof the shaft 4 is replaced by a one or multiple optical fibers or hollowfibers waveguides. The preferred light delivery means depends on thewavelength of the laser used. Infrared light emitted by the heatedtissue can also be collected through the window and used by an infrareddetector to measure the tissue temperature.

[0089] Non-Protrusion & Recession Embodiments

[0090] FIGS. 8A-F are enlarged plan or top views of several varieties ofshapes of the tip as used in upper face-lift procedures. FIG. 8A showsan oval shaped-tip in this viewing angle. FIG. 8B shows a rectangularshaped-tip in this viewing angle. FIG. 8C shows a serrated shaped-tip inthis viewing angle. FIG. 8D shows a grooved shaped-tip in this viewingangle. FIG. 8E shows a geometric shaped-tip in this viewing angle. FIG.8F shows a diamond shaped-tip in this viewing angle. For whatevervariety of tip is chosen, the customary size range of widths of thesetips varies between 12 mm and 20 mm and the thickness varies between 3mm and 4 mm. Adjacent or incorporated into the tip is thetissue-energizing area that allows the previously described forms ofenergy to cause tissue alteration directly above the path of theinstrument

[0091] High-Frequency Ultrasonic-Energized Embodiment

[0092]FIG. 9A is an enlarged plan or top view of ahigh-frequency-ultrasound-energized face-lift apparatus 1200. The tip1201 is secured to a shaft 1202 that may be tubular or flattened incross-sectional shape. The shaft may be made of metal or plastic orceramic and is connected to a plastic or polymer or ceramic tip sectionthat is covered or coated with the piezo material “PZT” or “leadpolymer” or PVDF that is “bonded in” and will transmit vibrationalenergy in the high range of ultrasound between 10 megahertz and 100megahertz to the target tissues. When viewed from the top, the shape ofthe “bonded in” ultrasonic transducers 1209 will preferably berectangular or geometric, however any number of imaginable shapes (forexample ellipsoid, circle, hourglass, diamond, spade, heart, club,separate islands, etc.) may be used with elements individually ormultiply bonded in the area. Electrical energy to power the “bonded in”ultrasonic transducers may be modulated or controlled by electronics1203 located in the handpiece which are in turn electrified viaelectrical cord 1204 and further controlled via external control unit1205 and attendant switch 1206. Alternatively, a switch 1208 may bepresent in the handle 1207 for easier controllability by the surgeon.

[0093]FIG. 9B is a side view of the of thehigh-frequency-ultrasound-energized face-lift apparatus 1200 showingelements identical to those in FIG. 9A in a different perspective. Thedesign or configuration of the “bonded in” segment will most desirablybe planar when viewed from the side and preferably be flush with theshaft or tip but may slightly protrude.

[0094] Reciprocating Energy Embodiment

[0095] An electrically-driven-reciprocating version of most of theenergized face-lift devices can be made by combining the followingdesigns in this section with the energized designs mentioned elsewherein this manuscript

[0096]FIG. 10A is a side view of the electrically-driven-reciprocatingface-lift apparatus 900. The tip 901 is secured to shaft 902 that may betubular or flattened in cross-sectional shape. The shaft may be made ofmetal or plastic that will conduct the kinetic energy in the form toforward/backward (to/fro) impulses of ½ mm to 2 cm generated by aninsulated electrical motor 903 located in the handpiece 909 which is inturn electrified via electrical cord 904 and controlled via control unit905 with switch 906.

[0097]FIG. 10B is an enlarged plan or top view of the of theelectrically-driven-reciprocating face-lift apparatus 900 showingelements identical to those in FIG. 10A in a different perspective.

[0098]FIG. 10C is a side view of the pneumatically-driven-reciprocatingface-lift apparatus 1000. The tip 1001 is secured to shaft 1002 that maybe tubular or flattened in cross-sectional shape. The shaft may be madeof metal or plastic that will conduct the kinetic energy in the form toforward/backward (to/fro) impulses of ½ mm to 2 cm generated by apneumatic actuator 1003 located in the handpiece which is in turnpneumatically energized via gas conduit 1004 connecting to externalpressurized gas source 1007 and controlled via control unit 1005 withswitch 1006.

[0099]FIG. 10D is a side view of the suction-driven-reciprocatingface-lift apparatus 1100. The tip 1101 is secured to shaft 1102 that maybe tubular or flattened in cross-sectional shape. The shaft may be madeof metal or plastic that will conduct the kinetic energy in the form toforward/backward (to/fro) impulses of ½ mm to 2 cm generated by asuction-activated-actuator with flapper-valve 1103 located in thehandpiece which is in turn suction-energized via gas conduit 1104connecting to external vacuum source 1107 and controlled via controlunit 1105 with switch 1106.

[0100] Electrosurgical/Radiofrequency-Energized Embodiment

[0101]FIG. 11 is a side view of the radiofrequency-energized face-liftface-lift apparatus 110. The tip 102 may be slightly larger than theshaft 104 to which it is attached. The tip 102 can be secured to shaft104 by a variety of methods such as a snap mechanism, mating grooves,plastic sonic welding, etc. The tip 102 is constructed of materials thatare both electrically non-conductive and of low thermal conductivity;such materials might be porcelain, ceramics or plastics. The shaft 104is tubular in shape or can be a somewhat flattened tube oblong in crosssection. The shaft 104 is made of metal with a hollow interior that willcontain insulated wire or wires 116. Alternatively, the shaft 104 may bemade of plastic that will act as its own insulation about wire or wires116. The wires 116 internal to shaft 104 conduct electrical impulses orRF signals from an electrosurgical handpiece 118 located in handle 106.These impulses are transmitted from a electrosurgical handpiece 118 tothe tip 102. Electrical energy is transmitted from an external generator(such as a Valleylab Surgistat, Boulder, Colo.) through standard wiringto the electrosurgical handpiece 118. In the embodiment shown here inFIG. 11, the shaft 104 is interlocked with the handle 106. The handle106 has a recess into which an electrosurgical handpiece 118 may beinstalled. As previously stated, the electrosurgical handpiece 118allows control of electrical or RF impulses sent to tip 102. Theelectrosurgical handpiece has a power control switch 120 to control itsfunction. A male/female connector 124 makes the connection between theelectrosurgical handpiece 118 and the wires 116. The electrosurgicalhandpiece 118 is secured in handle 106 by door 122. The electrosurgicalhandpiece 118 receives its power from an external source orelectrosurgical generator (source not shown in the figure). Atemperature sensor 135 is placed near the energized section of the tipto monitor tissue temperatures in order to create feedback or audibleoutput to the surgeon or a computer so as to controllably reduce theamount of radiofrequency or ultrasonic energy applied to the targettissues.

[0102]FIG. 12 is an enlarged plan or top view of the tip 102 as used inupper facelifts. This tip 102 shows five protrusions 126 and fourrecessions 128. The groove created by the tapering recessions may benoticeable up to one centimeter in length. The width W of this tipvaries between 12 mm and 20 mm and the thickness varies between 3 mm to4 mm. The tip, however, is not constrained by those dimensions. Alsoshown in FIG. 12 are the conductors 130 that transmit the signalssupplied by wire 116 from electrosurgical handpiece 118 to tip 102.Connection between conductors 130 embedded in tip 102 and wires 116 inshaft 104 is made at the time tip and shaft are joined.

[0103]FIG. 13 is another enlarged plan or top view of a tip 102. Thistip has three protrusions and two recessions and is the tip design usedin lower face-lift. The width W of this tip varies between 5 mm and 10mm while the thickness remains similar to the tip of FIG. 12 at 2 mm to3 mm. This tip, however, is not constrained by those dimensions. Shownalso are the conductors 130 for bringing power to the tip.

[0104]FIG. 14 is an enlarged partial cross section of a tip taken at14-14 of FIG. 12. Here is shown the relationship between the protrusions126 and the recessions 128. Also illustrated is the conductor 130.

[0105]FIG. 15 is an illustration of a face-lift apparatus similar tothose previously described. This apparatus differs in that shaft 104 isconstructed of a material that allows shaft 104 to have someflexibility. This may reduce the stress to some patient's delicate skinduring use. The shaft 104, however, must have enough rigidity to enablethe operator to maintain control over positioning the tip 102.

[0106]FIG. 16 is a face-lift apparatus again similar to those previouslydescribed but differing in that the electrosurgical handpiece 118 andhandle 106 have been combined to form integral unit 134. An optional andadditional feature in the handle or hand-piece can be an ultrasonicpiezoelectric transducer 132 that sends ultrasonic energy to the tip 102of the face-lift device. The wire 116 would need to be replaced by asmall metal shaft to conduct the ultrasonic energy. The shaft may bespecially insulated or coated (e.g., with Teflon) to protect surroundingtissue. Alternatively, to clear debris and to enhance efficiency, amotor capable of lower vibrational energy may be incorporated intohandle 34. Furthermore, uniform tissue heating element 117 may beincorporated on one side of the proximal tip and connected to insulatedconductive element 119 passing through the shaft 104. Conductive element119 and thus heating element 117 are controllably electrified at handle134. It is noteworthy that radiofrequency uniform tissue heating element117 (that may be located on a side of the proximal tip or shaft) isdistinct and separate from the radiofrequency elements located in thelysing areas of the tip. It is also noteworthy that uniform tissueheating element 117 may be controlled in a fashion independent from theradiofrequency elements in the lysing segments. A temperature sensor 135is placed near the energized section of the tip to monitor tissuetemperatures in order to create feedback or audible output to thesurgeon or a computer so as to controllably reduce the amount ofradiofrequency or ultrasonic energy applied to the target tissues. Thisloop may thus controllably restrict thermal tissue damage and optimizecontraction results. The temperature sensor 135 may be of an infraredtype, optical fiber type, an electronic type, or optical fluorescencetype, each being known in the prior art and thus a detailed descriptionthereof is deemed unnecessary.

[0107] Ionic Fluid/Electrosurgical-Energized “Arthrocare™” Embodiment

[0108]FIG. 17 represents a top or plan view of the ionic fluidelectrosurgical energized variant of the face-lifting device. Theelectrosurgical version of the face-lift device may be modified suchthat several sets of anodes 1303 and cathodes 1304 are placed inrelatively proximal locations at the end of the shaft 1301 or upon thetip 1302. This modification will result in an ionic fluid version 1300of the electrosurgical-energy embodiment. One or more sets of electrodes1303 and 1304 are placed in proximity to separate holes 1305 and 1306that allow the passage of ionic fluids able to conduct electrical energyinto the adjacent target tissue. The ionic fluids are brought into theshaft via individual conduits 1307 and 1308 that split off from thefluid source 1309 at point 1310 which may be proximal to or distal tothe handle 1311. FIG. 18 represents a side view of the ionic fluidelectrosurgical energized variant of the face-lifting device as shown inFIG. 17.

[0109]FIGS. 19A and B represent top views of the ionic fluidelectrosurgical energized variant of the face-lifting device.Specifically, the shape of the pattern 1312 of the multiplicity ofdrilled holes in the shaft or tip may be rectangular or geometric,however any number of imaginable shapes (for example ellipsoid, circle,hourglass, diamond, spade, heart, club, separate islands) may be used totransmit energy to the target tissues. The shaft and tip may beinsulated with materials such as Teflon®.

[0110] Thermal/Heating-Iron-Energized Embodiment

[0111]FIG. 20 is a side view of the face-lift apparatus 210. Window 250(dashed and hidden from clear view in this representation) allowsthermal energy to escape from within the shaft 204. The tip 202 may beslightly larger than the shaft 204. The tip 202 can be a separate piecethat is secured to shaft 204 by a variety of methods such as a snapmechanism, mating grooves, plastic sonic welding, etc. Alternatively, inthis model tip 202 can be integral or a continuation of shaft 204 madeof similar metal or materials. The tip 202 may also be constructed ofmaterials that are both electrically non-conductive and of low thermalconductivity; such materials might be porcelain, ceramics or plastics.Portions of the tip and shaft may be covered with Teflon to facilitatesmooth movement of the device under the skin. An optional electricallyconductive element 261 may be provided to bring RF electro surgicalenergy from RF source 218 to metal or electrically conductive elementsmounted in the recessions (see FIG. 21). The shaft 204 is tubular inshape or can be a somewhat flattened tube oblong in cross section. Theshaft 204 is made of metal with a hollow interior that can containinsulated wire or wires 261. Alternatively, the shaft 204 may be made ofplastic that will act as its own insulation about wire or electricallyconductive element 261. The optional electrically conductive element 261internal to shaft 204 conducts electrical impulses or RF signals from anoptional external power/control unit (such as a Valleylab Surgistat,Boulder, Colo.). An optional temperature sensor 235 placed near thedistal tip of the shaft is used to monitor the local temperature. Thisinformation can be used by the control electronics to control the energydelivered to the tip. An ultrasound transducer 232 can also be activatedto transmit energy to the tip 202 and provide additional heating andimprove lysing.

[0112]FIG. 21 is an enlarged plan or top view of the tip 202 as used inan upper face-lift or brow lift. This tip 202 shows four protrusions 226and three recessions 228. The groove created by the tapering recessionsmay be up to one centimeter in length. The width of this tip variesbetween 12 mm and 20 mm and the thickness varies between 3 mm and 4 mm.Optical window 250 allows thermal radiation to exit the shaft andirradiate tissue directly above the window. The user can enable ordisable the thermal source through a hand or foot switch (not shown).

[0113]FIG. 22 shows an off-center frontal view of the tip of theface-lift apparatus protrusions and recessions. The tip 202 has fourprotrusions 226 and three recessions 228 in which are seated electrodes281. The RF electrodes 281 located at the most proximal portion of thecutting recessions can increase lysing and coagulation at the cuttingedge. The RF electrodes 281 are connected by conducting wires 261 (FIG.22) to the power/control unit. The user can enable or disable the RFpower through a hand or foot switch (not shown). Window 250, allowingegress of thermal radiation and temperature sensor 235 are also locatedon the tip and may be of varying sizes. The width of this tip variesbetween 5 mm and 10 mm while the thickness may vary between 2 mm and 4mm. The tip, however, is not constrained by those dimensions.

[0114]FIG. 23 shows a cross sectional view of an embodiment of theface-lift device 310 of the present invention. The shaft 304 with thespecial lysing tip 302 is inserted through an opening at a suitablelocation on the face of a patient. The apparatus may then be thrustforwardly while lifted forcefully by the operator to perform itsfunction and maintain the plane of undermining. A hot filament 313within the device is heated by flowing current through connecting wires365. The filament 313 is held rigidly in position within the paraboliccavity by the strength of the wire 365. Alternately, the filament 313 isfixedly attached to the shaft 304. The hot filament 313 emits opticaland thermal radiation 345 that can directly exit window 350 or bereflected off a reflector 314 to also exit through window 350. Thereflector 314 can have a parabolic shape to effectively collect alloptical and thermal radiation emitted away from the window 350. The hotfilament 313 can be a tungsten carbide filament similar to those used inhigh power light bulbs. The wavelength may be adjusted and controlled byadjusting the filament temperature/current. The window 350 can beselected from a wide variety of glass that transmits optical, nearinfrared and infrared light (e.g., quartz, fused silica and germanium.)The tissue penetration depth depends on the wavelength of the light(e.g., 1 μm penetrates through 10 mm, 10 μm penetrates through 0.02 mm).The broad emission spectrum from the hot filament 313 can be filtered bywindow 350 to achieve the desired tissue effect. In particular filteringthe emission spectrum to heat the dermis to temperatures ofapproximately 70° C. will cause the desired collagen shrinkage andtightening. The optimum spectral filtering depends on skin thickness andstructure. A temperature sensor 335 connected to the control unit byelectrical wire 367 monitors the temperature of tissue that is incontact with the shaft 304. In order to eliminate excessive heating ofthe shaft 304 and the surrounding facial tissue, the heating element 313and reflector 314 are thermally isolated by low thermal conductivitymaterials. The heating element is isolated by not touching the shaft,whereas the reflector can have an isolating layer where it attaches tothe shaft. In addition, cold nitrogen gas can be injected through tube370 and pumped out through the hollow shaft to cool the tip 302 andshaft 304. Flowing nitrogen gas (or another inert gas) through thehollow shaft also reduces oxidation damage to the filament.

[0115]FIG. 24 shows an alternative embodiment of the present inventionthat reduces the thermal load to the shaft 404 and eliminates the needfor high electrical currents within the shaft. In this embodiment thehot filament 413 is located in the handle 420 of the device and isconnected to the power unit by wires 465 and cable 475. The optical andthermal radiation 445 is transported through the hollow wave-guidewithin the shaft 404 and reflected off the mirror 416 through the window450. The absorption coefficient within the wave-guide is inverselyproportional to the cube of the height of the hollow wave-guide withinthe shaft and can be made small for the hot filament 413 when operatedat temperatures greater than 600 degrees. The absorbed energy would beevenly distributed over the entire shaft 404 and the average temperatureincrease would be small. A mirror reflector 414 redirects radiationemitted away from the shaft down the shaft to improve overall systemefficiency. A temperature sensor 435 connected to the control unit byelectrical wire 467 and cable 475 monitors the temperature of tissuethat is in contact with the shaft 404. The ability to continuouslymonitor the temperature greatly reduces the danger of overheating andtissue carbonization. In addition, cold nitrogen gas can be injectedthrough tube 470 to cool the tip 402 and shaft 404. The nitrogen gas canexit through the handle 420 or be recirculated through a cooling system.Flowing nitrogen gas through the hollow shaft also reduces oxidationdamage to the filament. A cable 480 connects the present device to thecontrol/power unit.

[0116]FIG. 25 shows an alternative embodiment of the present inventionin which tissue heating is achieved by the direct contact with a hotsurface 555. In this embodiment electric current flowing through wires565 heat a resistive load 555 to a user selected temperature. For mostapplications the temperature will be less than 80° C. to induce collagenshrinkage but prevent thermal collateral damage. This embodimenteliminates the risk that any tissue region can be heated above thedesired temperature by misuse. This allows the size of the hot surface555 to be larger (e.g. several centimeters long, 1 centimeter wide)which can speed up the procedure. In addition, the hot surface 555 canbe made up of multiple elements that can be set to different desiredtemperatures. The resistive load could be a thin film resistor and thefilm temperature could be estimated from the measured resistance.Alternatively a separate temperature sensor 535 can be placed close tothe heating element. The measured temperature is used by the controlunit to control the current through the resistive load. In order toreduce heating to the shaft 504 and tip 502, cold gas or liquid can beinjected through tube 570 and pumped out through the hollow shaft. Thespecific shape of the heater 555 and surface temperature can be adjustedto obtain the desired tissue coagulation depth. Instead of a resistiveload, the heating element could be the hot side of a Peltierthermoelectric cooler. An advantage of a thermoelectric cooler is thatthe opposite surface is cooled below ambient temperature. Single stagethermoelectric coolers can achieve temperature differences of up to 40°C. By thermally connecting the cold surface of the thermoelectric coolerto the bottom of the shaft the cooler can be used to reduce heating ofthe shaft away from the hot surface.

[0117] In all embodiments of the device the shaft can be coated with abiocompatible non-stick material such as Teflon® to reduce tissuesticking to the device during the procedure.

[0118] Microwave-Energized Embodiment

[0119]FIG. 26 is an enlarged plan or top view of a microwave-energizedface-lift apparatus 1400. The tip 1401 is secured to shaft 1402 that maybe tubular or flattened in cross-sectional shape; the shaft is furtherattached to handle 1403. The shaft may be made of metal or plastic orceramic is connected to a plastic or polymer or ceramic tip section thathas an even total number of phased array antennas 1404 attached orexposed on a planar or relatively planar or slightly curviform side. Thephased array of antennas is made of metal (preferably stainless steel,aluminum, gold, steel, or platinum). The phased array is able tofunction in the range of 1 to 10 gigahertz yielding up to 20 watts ofpower with a depth of penetration of 1-3 mm. Opposing signs 1405, 1406,1407, 1408, 1409, and 1410 are placed adjacent to control the depth oftissue penetration of microwave energy. Phases of electromagnetic fieldin different elements are fixed. Electric fields cancel at distance butallow and effect to nearby tissue. When viewed from the top the shape ofthe phased array of antennas will preferably be rectangular orgeometric, however any number of imaginable shapes (for exampleellipsoid, circle, hourglass, diamond, spade, heart, club, separateislands). Electrical energy to power the phased array of antennas may bemodulated or controlled by electronics 1411 located in the handpiecewhich are in turn electrified via electrical cord 1412 and furthercontrolled via external control unit 1413 and attendant switch 1414.Alternatively, a switch 1415 may be present in the handle 1403 foreasier controllability by the surgeon.

[0120]FIG. 27 is a side view of the of the microwave-energized face-liftapparatus 1400 showing elements identical to those in FIG. 26 in adifferent perspective. The design or configuration of the “phased array”1404 will most desirably be planar when viewed from the side andpreferably be flush with the shaft or tip but may slightly protrude.

[0121] The foregoing description of preferred embodiments of theinvention is presented for purposes of illustration and description andis not intended to be exhaustive or to limit the invention to theprecise form disclosed. Many modifications and variations are possiblein light of the above teaching. The embodiments were chosen anddescribed to best explain the principles of the invention and itspractical application to thereby enable others skilled in the art tobest use the invention in various embodiments and with variousmodifications suited to the particular use contemplated.

We claim:
 1. A face-lift apparatus, comprising: a shaft having aproximal end and a distal end; means for lysing tissue; and meansconnected to said shaft for providing energy to targeted tissue.
 2. Theface-lift apparatus of claim 1 , wherein said means for lysing tissuecomprise a plurality of protruding members on said distal end of saidshaft separated by at least one lysing segment that is recessed relativeto said protruding members.
 3. The apparatus of claim 1 , wherein saidmeans for providing energy comprises means for providing thermalradiation.
 4. The apparatus of claim 1 , wherein said shaft comprises anoptical window, wherein said means for providing energy comprises meansfor providing laser radiation for transmission through said opticalwindow to targeted tissue.
 5. The apparatus of claim 2 , wherein alysing segment of said at least one lysing segment comprises anelectrode, wherein said means for providing energy comprises means forproviding radiofrequency radiation from said proximal end of said shaftto said electrode in said lysing segment so that radiofrequency energycan be transmitted through said electrode.
 6. The apparatus of claim 3 ,wherein said means for providing thermal radiation comprises a segmentthat may be heated, wherein said segment is located near said distal endof said shaft and connected to said shaft, wherein said segment can heattissue directly.
 7. The apparatus of claim 6 , wherein said segmentcomprises a thin film resistor, wherein said apparatus further comprisesmeans for flowing a current through said thin film resistor.
 8. Theapparatus of claim 3 , wherein said means for providing thermalradiation includes an optical window in said shaft, wherein said opticalwindow is operatively positioned for transmitting thermal radiation tosaid tissue.
 9. The apparatus of claim 1 , further comprising atemperature sensor fixedly connected to said shaft, wherein saidtemperature sensor is operatively connected near said distal end of saidshaft to monitor tissue temperature.
 10. The apparatus of claim 9 ,further comprising control electronics that process said tissuetemperature to control said radiation for optimum tissue contraction.11. The apparatus of claim 10 , further comprising a user interfaceoperatively connected to said control electronics.
 12. The apparatus ofclaim 11 , wherein said user interface comprises a touch pad.
 13. Theapparatus of claim 4 , further comprising means for providing visibleradiation for transmission through said optical window to aid in adetermination of the location of said window when said window is beneathtissue.
 14. The apparatus of claim 1 , further comprising an ultrasoundtransducer within said shaft, wherein said ultrasound transducer isoperatively connected near said distal end for providing ultrasoundenergy to said tissue.
 15. The apparatus of claim 2 , wherein said atleast one lysing segment comprises a sharpened edge that effectivelylyses tissue that comes into contact with said distal end as saidapparatus is pushed forward.
 16. The apparatus of claim 3 , wherein saidmeans for providing thermal radiation comprises a filament.
 17. Theapparatus of claim 9 , wherein said temperature sensor is selected froma group consisting of an infrared temperature sensor, a fiber opticfluorescence temperature sensor, a thermal resistance sensor and athermocouple sensor.
 18. The apparatus of claim 2 , wherein said lysingsegment comprises means for providing radio frequency energy to improvetissue lysing and provide tissue heating.
 19. The apparatus of claim 1 ,wherein said distal end is attached to said shaft by a mechanismselected from a group consisting of a snap mechanism, mating grooves anda plastic sonic weld.
 20. The apparatus of claim 1 , wherein said shaftcomprises material that is both electrically non-conductive and of lowthermal conductivity.
 21. The apparatus of claim 19 , wherein said shaftcomprises material selected from a group consisting of porcelain,ceramic and plastic.
 22. The apparatus of claim 1 , wherein said shaftis at least partially covered with Teflon® to facilitate smooth movementof said apparatus under skin.
 23. The apparatus of claim 16 , whereinsaid filament comprises a tungsten carbide filament.
 24. The apparatusof claim 23 , further comprising a reflector operatively positioned nearsaid filament to effectively reflect optical and thermal radiationthrough said optical window.
 25. The apparatus of claim 4 , wherein saidoptical window comprises glass selected from a group consisting ofquartz, fused silica and germanium.
 26. The apparatus of claim 4 ,wherein said optical window comprises an optical filter.
 27. Theapparatus of claim 1 , further comprising means for controlling theheating of said shaft.
 28. The apparatus of claim 27 , wherein saidmeans for controlling the heating of said shaft comprises means forthermally isolating said shaft from said means for providing energy. 29.The apparatus of claim 27 , wherein said means for controlling theheating of said shaft comprises means for flowing an inert gas throughsaid shaft.
 30. The apparatus of claim 16 , wherein said filament islocated near said distal end.
 31. The apparatus of claim 16 , whereinsaid means for providing thermal radiation comprises a mirror fixedlyand operatively located near said distal end, wherein said filament islocated near said proximal end, wherein said shaft comprises a hollowwaveguide, wherein thermal and optical radiation from said filament aretransported through said hollow wave-guide and reflected off said mirrorand through said optical window.
 32. The apparatus of claim 31 , furthercomprising a reflector operatively located near said filament to directradiation emitted away from said distal end toward said mirror.
 33. Theapparatus of claim 4 , wherein said means for lysing tissue comprise aplurality of protruding members on said distal end of said shaftseparated by at least one lysing segment that is recessed relative tosaid protruding members, wherein said protruding members form a planarsurface, and wherein said optical window is positioned such that lighttransmitted through said optical window deviates from said planarsurface by an angle of at least 5 degrees.
 34. The apparatus of claim 4, wherein said means for delivering laser light comprises at least oneoptical fiber in said shaft.
 35. The apparatus of claim 4 , wherein saidmeans for delivering laser light comprises a waveguide in the shaft. 36.The apparatus of claim 4 , wherein said shaft is hollow and has an innersurface selected from the group consisting of a reflective inner surfaceand a polished metal inner surface.
 37. The apparatus of claim 4 ,further comprising control means for controlling the delivery of laserlight to said distal end of said shaft.
 38. The apparatus of claim 4 ,wherein said means for providing laser radiation include a source oflaser light selected from the group consisting of a CO₂ laser, anerbium-YAG laser and a holmium laser.
 39. The apparatus of claim 2 ,wherein said at least one lysing segment comprises at least oneelectrode, wherein at least a portion of said distal end of said shaftis formed of an electrically non-conductive material except for saidelectrode.
 40. The apparatus of claim 39 , wherein the non-conductivematerial is selected from the group consisting of plastics, graphite,graphite-fiberglass composites, ceramics, and glasses.
 41. The apparatusof claim 39 , wherein said means for delivering energy comprises atleast one insulated conductive member in said shaft.
 42. The apparatusof claim 1 , further comprising means for delivering ultrasonic energyto the distal end of the shaft.
 43. The apparatus of claim 39 , furthercomprising control means for controlling the delivery of said energy tothe distal end of the shaft.
 44. The apparatus of claim 43 , furthercomprising a temperature sensor that senses the temperature at thedistal end of the shaft, wherein the sensor sends a signal to thecontrol means, and wherein said control means controls the delivery ofsaid energy to the distal end to adjust the temperature.
 45. Theapparatus of claim 39 , wherein said electrode is unipolar.
 46. Theapparatus of claim 39 , wherein said at least one lysing segmentcomprises at least two electrodes, and wherein said means for deliveringenergy comprises at least two insulated conductive wires in the shaft,each wire connected to an electrode, and wherein the electrodes comprisea bipolar electrode.
 47. The apparatus of claim 39 , wherein thethickness of the distal end of the shaft is less than about 1 cm and thewidth of the distal end is less than about 2 cm.
 48. The apparatus ofclaim 39 , wherein at least one of the protruding members has an openingat the distal end.
 49. The apparatus of claim 39 , further comprising atleast one lumen extending through at least a portion of the shaft andterminating at the opening.
 50. The apparatus of claim 49 , wherein saidat least one lumen is attached to a vacuum source.
 51. The apparatus ofclaim 39 , additionally including a handle which may contain an optionalultrasonic transducer piezoelectric and thus may impart ultrasonicenergy to the shaft and thereby the tip.
 52. The apparatus of claim 39 ,additionally including a handle which is composed of empty polyurethaneor deformable or malleable or resilient plastic or polymer that canaccommodate a standard electrosurgical handle.
 53. The apparatus ofclaim 39 , additionally including a handle capable of attaching to anelectrosurgical generator for unipolar or bipolar functionality.
 54. Theapparatus of claim 39 , wherein said distal end of the shaft is of aconfiguration selected from the group consisting of round or tapered.55. The apparatus of claim 29 , wherein said means for flowing an inertgas through said shaft comprises means for flowing cold nitrogen. 56.The apparatus of claim 22 , wherein said Teflon® does not cover at leasta portion of said means for lysing tissue.
 57. The apparatus of claim 1, wherein said means connected to said shaft for providing energy totargeted tissue include means for providing energy in a plane.